Provider Demographics
NPI:1861622623
Name:KIEFER, CASEY MOORE (DDS)
Entity type:Individual
Prefix:DR
First Name:CASEY
Middle Name:MOORE
Last Name:KIEFER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8470 FALLS OF NEUSE RD.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615
Mailing Address - Country:US
Mailing Address - Phone:919-977-0627
Mailing Address - Fax:919-977-4079
Practice Address - Street 1:3415 ROGERS RD.
Practice Address - Street 2:SUITE 100
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587
Practice Address - Country:US
Practice Address - Phone:919-554-9955
Practice Address - Fax:919-554-9933
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1507481223G0001X
NC88571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice